Care, Custody, and Consent to Treat Form

CARE, CUSTODY, & CONSENT TO TREAT


Owner / Agent Info

Who is submitting this form?(Required)
Name
Address

Equine Information

Sex

Consent Section

Consent 1(Required)
Consent 2(Required)
Consent 3(Required)
Consent 4(Required)
Consent 5(Required)
Consent 5(Required)

Signature(s) Section

I hereby state that I have read and understood this care, custody and control agreement and acknowledge receipt of a copy thereof.

Owner Signature Date(Required)
Agent Signature Date
Witness Signature Date